Adapting trauma guidelines and point-of-care diagnostics improves LMIC polytrauma outcomes
This narrative review synthesizes literature on adapting global trauma guidelines for adult polytrauma in low- and middle-income countries. Investigators report that integrating context-sensitive protocols, point-of-care ultrasound, and viscoelastic-guided transfusion can optimize patient management despite systemic barriers like training deficits and blood bank shortages. The authors propose scalable interventions, including phased trauma training, hybrid emergency departments, and digital registries, to reduce mortality without requiring high-income infrastructure. These findings emphasize that localized investments in diagnostics, transfusion logistics, and surveillance are essential for strengthening trauma care in resource-limited settings.
The original study
Strengthening trauma care in low- and middle-income countries through guideline adaptation and scalable system reforms.
- Authors
- Le KL, Pham TN, Tran MQ, Trinh MT, Pham PC, Duong-Ngoc QN, et al.
- Journal
- World journal of methodology
- Type
- Journal Article, Review
- PMID
- 42625973
Original abstract
Trauma is a leading global cause of death and disability, with nearly 90% of fatalities occurring in low- and middle-income countries (LMICs), where prehospital care, infrastructure, and trained personnel are limited. This narrative review synthesizes literature (2019-2025) on the initial management of adult polytrauma, and explores strategies to adapt global guidelines in resource-constrained settings. Contemporary frameworks such as advanced trauma life support (ATLS) and World Health Organization essential trauma care emphasize context-sensitive sequencing, permissive hypotension, balanced transfusion, damage-control surgery, and integration of point-of-care ultrasound. Adjuncts including tranexamic acid, viscoelastic-guided transfusion, prehospital whole blood, and selective aortic balloon occlusion offer incremental survival benefits. However, widespread barriers-training deficits, blood bank shortages, lack of imaging, and absent trauma registries-impede implementation. Emerging models demonstrate that scalable solutions such as primary trauma care courses, phased ATLS rollouts, hybrid emergency rooms, and tablet-based registries can reduce mortality and referral delays without requiring wholesale adoption of high-income systems. Meaningful progress requires adapting evidence-based guidelines to local realities, supported by investments in education, diagnostics, transfusion logistics, and national surveillance. Future work should quantify cost-effectiveness and refine context-specific frameworks to close the outcome gap in LMICs.